肝再生增强因子在HBV相关肝硬化患者中的表达及意义  

Clinical significance of serum levels of augmenter of liver regeneration in patients with HBV-related cirrhosis

作　　者：陈文[1] 杨春[2] 毕义亮 唐黎[1] 吴刚[1] 邓存良[1] 

机构地区：[1]泸州医学院附属医院感染科,四川省泸州市646000 [2]泸州医学院附属医院消化内科,四川省泸州市646000

出　　处：《世界华人消化杂志》2014年第3期434-438,共5页World Chinese Journal of Digestology

基　　金：泸州市科技局基金资助项目;No.2013-S-48(1/30)~~

摘　　要：目的:研究肝再生增强因子(augmenter of liver regeneration,ALR)在乙型肝炎病毒(hepatitis B virus,HBV)相关肝硬化患者中的表达及临床意义.方法:病例来源于我科门诊及住院的慢性乙型肝炎患者,包括性慢性乙型肝炎轻度组(n=196)、代偿期肝硬化组(n=69)、失代偿期肝硬化组(n=148);失代偿肝硬化患者根据并发症进一步分为腹水组(n=51)、消化系出血组(n=32)、肝性脑病组(n=27)和慢性肝衰竭组(n=38),其中腹水组分为原发性腹膜炎组(n=9)与非原发性腹膜炎组(n=42).健康对照组(n=200)来源于输血科健康献血者.收集患者血清及临床资料;采用ELISA法检测各组患者血清ALR浓度;瞬时弹性扫描(FibroScan)检测代偿期肝硬化患者肝脏硬度.比较各组间ALR浓度差异,分析ALR浓度与肝硬化及其并发症的关系.结果:ALR浓度在代偿期肝硬化组和失代偿肝硬化组均明显高于健康对照组和慢性乙型肝炎轻度组(P<0.01).在代偿期肝硬化患者ALR浓度(1.54μg/L±0.53μg/L)与肝脏FibroScan值(16.96 kPa±5.6 kPa)负相关(r2=-0.218,F=15.736,P<0.01).失代偿肝硬化组中慢性肝衰竭患者ALR浓度明显高于代偿期肝硬化组(1.73μg/L±0.23μg/L vs 1.54μg/L±0.53μg/L,P=0.012),腹水组患者ALR浓度明显低于代偿期肝硬化组(1.32μg/L±0.64μg/L vs 1.54μg/L±0.53μg/L,P=0.027),原发性腹膜炎组与非原发性腹膜炎组间ALR浓度无显著性差异.ALR血清浓度与肝硬化患者腹水的发生相关,低ALR血清浓度是肝硬化患者发生腹水的危险因素(P=0.031,OR=0.841).结论:ALR在HBV相关肝硬化患者表达明显升高,其水平与肝脏硬度及腹水发生负相关,提示ALR在肝硬化患者增高可能是机体的一种保护机制.AIM： To determine serum levels of augmenter of liver regeneration （ALR） in patients with HBV- related cirrhosis and to nificance. analyze its clinical sig- METHODS： Serum samples were collected from patients with mild chronic hepatitis B （n = 196）, compensated cirrhosis （n = 69）, decompensated cirrhosis （n = 148） and normal controls （n = 200）. The patients with decompensated cirrho- sis were divided into an ascites subgroup （n =51）, a gastrointestinal bleeding subgroup （n = 32）, a hepatic encephalopathy subgroup （n = 27） and a chronic liver failure subgroup （n = 38）. The patients with ascites were further divided into a spontaneous bacterial peritonitis （SBP） subgroup （n = 9） and a non-SBP group （n = 42）. Serum concentrations of ALR were measured by ELISA. FibroScan was used to test the liver stiff- ness of patients with compensated cirrhosis. The correlation between ALR level and FibroScan score was analyzed by linear regression analysis. Unconditioned binary response logistic regres- sion model was used to determine the correla- tion between ALR level and the occurrence of complications in patients with decompensated cirrhosis. RESULTS： Serum ALR concentrations were higher in the compensated cirrhosis group and decompensated cirrhosis group than in the mild chronic hepatitis B group and normal control group （P 〈 0.01 for all）. There was a negative correlation between serum ALR concentration and FibroScan score in patients with compensat- ed cirrhosis （r = -0.218, F = 15.736, P 〈 0.01）. Serum ALR concentrations in patients with chronic liver failure were higher than those in patients with compensated cirrhosis （1.73 μg/L ±0.23 μg/L vs 1.54 μg/L ± 0.53 μg/L, P = 0.012）, and ALR concentrations in patients with ascites were significantly decreased （1.32 μg/L ± 0.64 ~g/L vs 1.54 μg/L ± 0.53 μg/L, P = 0.027）. There was no significant difference in ALR levels between the SBP group and non-SBP group. Logistic regression analysis identi

关 键 词：肝再生增强因子 乙型肝炎病毒 肝硬化 临床意义 

分 类 号：R575.2[医药卫生—消化系统]